1803 The varied grammars of infant deaths: ‘Fifth-night’s sickness’, ‘ninth-day sickness’ and the scourge of neonatal tetanus in Scotland

BackgroundNeonatal tetanus has killed many infants. Its impact on human history is difficult to estimate. Even in 2019 fewer than 5% of deaths from this preventable illness were reported to the WHO maternal and neonatal tetanus elimination program. Of the many reasons for under-reporting, variation in its nomenclature within communities remains a challenge.ObjectivesTo identify names employed to describe infant tetanus in an extensive set of historical documents from Scotland.MethodsThe First (Old) Statistical Account of Scotland included population records collected by 900 parish ministers between 1790 and 1799. We carefully examined these to identify information relating to infant deaths. Comparisons have been made with accounts of neonatal deaths in that period from Europe, the Caribbean, southern states of America and Brazil.ResultsRecords from 1791 described Scottish infants dying of an ‘eight-day sickness’ in Kilbride, Arran, and a ‘fifth-night’s sickness’ in Stornoway. A visiting surgeon referred to these conditions as infant lockjaw or trismus infantum. In Barvas an illness called five or seven night’s sickness was described, in Uig an epilepsy among very young infants. Accounts from Skye recorded infants dying in the first and second weeks of life of ‘pleurisy’. No ministers compared cases of this condition with those in neighbouring areas or other countries. The problem was described as having disappeared in Arran by the 1840s, although at this time it became a growing problem on St Kilda. Joseph Clarke documented clusters of cases of trismus nascentium in the Dublin Lying In Hospital in the 1780s. In 1791 a gold medal was offered in Madrid to find a treatment for the scourge of ‘mal de barretas’ or ‘trisme del nado’. In St Dominigue where infant deaths compromised the growth of the enslaved workforce, the Cercle des Philadelphes published a report on trismus nascentium in 1786. European records included the terms ginklofi or jaw-falling (Iceland), gichteren (Germany), klamper (Norway), mal de sete dias (Portugal and Brazil), mal a machior, pasmo or spasmo (Spain and Puerto Rico). Many sources recorded seizures as a cause of neonatal deaths. Descriptive terminologies focused on the fearsome impacts of tetanus: initially on feeding, then the infant’s face or jaw, followed by muscular spasms with gasping. These infants became ill and perished in the first weeks of life. Scottish nomenclature noted more gently the timings of commencement of symptoms.ConclusionsThe early weeks of infant existence were poorly documented prior to the nineteenth century. Neonatal tetanus was described earlier in urban and rural settings, temperate or tropical communities, Hospitals and homes. Variation in nosology was one of several factors limiting communications about this fatal illness. This deprived parents of an explanation or causation. Crucially it delayed the sharing of preventive best practices among birth assistants.